Evaluating the Impact of Penile Girth Discrepancy on Patient Bother in Men With Peyronie's Disease: An Observational Study

Background: Men with Peyronie's disease (PD) may experience penile narrowing. Little data on penile girth changes and their psychosocial impact exist. Aim: To assess girth discrepancy in men with PD and its association with patient bother. Methods: This was a retrospective observational study. All patients with PD at our institution who were seen in the sexual medicine clinic and who completed 3 validated instruments the PD questionnaire (PDQ), Self-Esteem and Relationship (SEAR) questionnaire, and a depression questionnaire, the Center for Epidemiologic Studies Depression Scale (CES-D), and a curvature assessment were included. Patient and PD characteristics are described. Associations of instability and bother to girth differences are assessed. 2 outcomes for girth differences are classified as (i) girth difference of >= 1 cm vs less and (ii) girth differences of >= 10% vs less. Unadjusted and adjusted effects of PD and patient characteristics are assessed on the outcome of high bother using logistic regression models. Outcomes: The main outcomes of this study were penile girth changes, instability, and questionnaire scores. High bother was defined as a PDQ bother score of >= 9. Results: A total of131 men had midshaft curvature and were the focus of the study. Their mean age was 59 +/- 9 (range 31-78) years. PD duration was 16 +/- 25 (range 1-180) months, with a mean degree of primary curvature of 37 +/- 20 degrees. Mean girth difference between base and point of maximum curvature was 0.78 +/- 0.53 cm equating to a mean girth difference at point of maximum curvature of 6 +/- 4%. Instability was present in 53% of men. There were 54 men with a girth difference of >= 1 cm and 23 men with a >= 10% change in girth. There was no difference in CES-D, SEAR, or PDQ domain scores or high bother in men with significant girth changes. Univariable analysis of predictors of high bother included the degree of curvature (odds ratio [OR]: 1.06; P <.001), instability (OR 6.62; P <.001), CES-D sum (OR 1.09; P =.002), and SEAR score (OR 0.96; P=.001). On multivariate analysis, only the degree of primary curvature was predictive of high bother (OR 1.06; P <.001). Clinical Implications: Penile girth changes have little impact on overall psychosocial well-being. The degree of penile curvature is the primary predictor of patient bother. Strengths and Limitations: Strengths include a large patient population and use of validated questionnaires. Limitations include single-center, retrospective study and subjective instability grading. Conclusions: Penile girth discrepancy in men with PD has limited psychosocial impact. Clinically significant bother was associated with the degree of primary curvature.